Community Mental Health Journal

, Volume 48, Issue 6, pp 804–812

A Cross-cultural Study of Recovery for People with Psychiatric Disabilities Between U.S. and Japan

Original Paper


The concept of recovery has been expanding overseas with remarkable speed. The Recovery Assessment Scale (RAS) is one of the measures widely used to capture self-perceptions of a sense of recovery for people with psychiatric disabilities. The current study tested measurement invariance of RAS between the US and Japanese samples for people with psychiatric disabilities, which is a precursor of further cross-cultural comparisons without any contamination of systematic cultural bias. A multiple-group confirmatory factor analysis was applied to US (N = 446) and Japanese (N = 214) participants for testing configural, loading, and intercept invariance. The results revealed that RAS items equally captured their associated recovery domains between American and Japanese participants. For two domains, “personal confidence and hope” and “reliance on others,” the two groups systematically responded with different patterns. Different cultural environments may have additive influences toward people’s response patterns to their recovery across countries.


Recovery Mental illness Cross-cultural study Recovery Scale Measurement invariance Japanese Confirmatory factor analysis 


  1. Averill, J. R., & Sundararajan, L. (2005). Hope as rhetoric: Cultural narratives of wishing and coping. In J. Eliott (Ed.), Interdisciplinary perspectives on hope (pp. 133–165). New York: Nova Science Publishers.Google Scholar
  2. Birchwood, M., Cochrane, R., Macmillan, F., Copestake, F., Kucharska, J., & Cariss, M. (1992). The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean, and White patients. British Journal of Psychiatry, 161, 783–790.PubMedCrossRefGoogle Scholar
  3. Bleuler, M. (1978). The schizophrenic disorders. New Haven, CT: Yale University Press.Google Scholar
  4. Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.Google Scholar
  5. Borsboom, D. (2006). When does measurement invariance matter? Medical Care, 44, 176–181.CrossRefGoogle Scholar
  6. Brislin, R. W., Lonner, W., & Thorndile, R. M. (1973). Cross-cultural research methods. New York: Wiley.Google Scholar
  7. Brown, T. (2006). Confirmatory factor analysis for applied research. New York: The Gulford Press.Google Scholar
  8. Byrne, B. M., Shavelson, R. J., & Muthen, B. (1989). Testing for the equivalence of factor covariance and mean structures: The issue of partial measurement invariance. Psychological Bulletin, 105, 456–466.CrossRefGoogle Scholar
  9. Chang, E. C., Asakawa, K., & Sanna, L. J. (2001). Cultural variations in optimistic and pessimistic bias: Do easterners really expect the worst and westerners really expect the best when predicting future life events? Journal of Personality and Social Psychology, 81, 476–491.PubMedCrossRefGoogle Scholar
  10. Cheung, G. W., & Rensvold, R. B. (1999). Testing factorial invariance across groups: A reconceptualization and proposed new method. Journal of Management, 25(1), 1–27.CrossRefGoogle Scholar
  11. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233–255.CrossRefGoogle Scholar
  12. Chiba, R., Miyamoto, Y., & Kawakami, N. (2010). Reliability and validity of the Japanese version of the Recovery Assessment Scale (RAS) for people with chronic mental illness: Scale development. International Journal of Nursing Studies, 47, 314–322.PubMedCrossRefGoogle Scholar
  13. Ciompi, L., & Muller, C. (1976). The life-course and aging of schizophrenics: A long-term follow-up study into old age. Berlin, Germany: Springer.Google Scholar
  14. Copeland, M. E. (2002). Wellness Recovery Action Plan: A system for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings. Occupational Therapy in Mental Health, 17, 127–150.CrossRefGoogle Scholar
  15. Corrigan, P. W., Mueser, K. T., Bond, G. R., Drake, R. E., & Solomon, P. (2008). Principles and practice of psychiatric rehabilitation: An empirical approach. New York, NY: The Guilford Press.Google Scholar
  16. Corrigan, P., Salzer, W., Ralph, R., Sangster, Y., & Keck, L. (2004). Examining the factor structure of the recovery assessment scale. Schizophrenia Bulletin, 30, 1035–1041.PubMedCrossRefGoogle Scholar
  17. Davidson, L., Borg, M., Marin, I., Topor, A., Mezzina, R., & Sells, D. (2005). Process of recovery in serious mental illness: Findings from a multinational study. American Journal of Psychiatric Rehabilitation, 8, 177–201.CrossRefGoogle Scholar
  18. DeSisto, M. J., Harding, C. M., McCormick, R. V., Ashikaga, T., & Brooks, G. W. (1995a). The Maine and Vermont three-decade studies of serious mental illness: I. Matched comparison of cross-sectional outcome. British Journal of Psychiatry, 167, 331–338.PubMedCrossRefGoogle Scholar
  19. DeSisto, M. J., Harding, C. M., McCormick, R. V., Ashikaga, T., & Brooks, G. W. (1995b). The Maine and Vermont three-decade studies of serious mental illness: II. Longitudinal course comparisons. British Journal of Psychiatry, 167, 338–342.PubMedCrossRefGoogle Scholar
  20. Gregorich, S. E. (2006). Do self-report instruments allow meaningful comparisons across diverse population groups? Testing measurement invariance using the confirmatory factor analysis framework. Medical Care, 44, 78–94.CrossRefGoogle Scholar
  21. Harding, C. M., Brooks, G., Ashikage, T., Strauss, J. S., & Brier, A. (1987). The Vermont longitudinal study of persons with severe mental illness II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144, 727–735.PubMedGoogle Scholar
  22. Heine, S. J., & Lehman, D. R. (1995). Cultural variation in unrealistic optimism: Does the west feel more invulnerable than the East? Journal of Personality and Social Psychology, 68, 595–607.CrossRefGoogle Scholar
  23. Huber, G., Gross, G., & Schüttler, R. (1975). A long-term follow-up study of schizophrenia: Psychiatric course and prognosis. Acta Psychiatrica Scandinavica, 52, 49–57.PubMedCrossRefGoogle Scholar
  24. Jablensky, A. (1989). Epidemiology and cross-cultural aspects of schizophrenia. Psychiatric Annals, 19, 516–524.Google Scholar
  25. Lee, J., Preacher, K. J., & Little, T. D. (2010). Partial factorial invariance in cross-cultural comparisons. In E. Davidov, P. Schmidt, & J. Billiet (Eds.), Cross-cultural data analysis: Methods and applications (pp. 57–86). New York: Guilford Press.Google Scholar
  26. Liberman, R. P., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept in search of research. Psychiatric Services, 56, 735–742.PubMedCrossRefGoogle Scholar
  27. Little, T. D. (1997). Mean and covariance structures (MACS) analyses of cross-cultural data: Practical and theoretical issues. Multivariate Behavioral Research, 32(1), 53–76.CrossRefGoogle Scholar
  28. Little, T. D., & Slegers, D.W. (2005). Factor analysis: Multiple groups with means. In B. Everitt, D. Howell & D. Rindskopf (Eds.), Encyclopedia of statistics in behavioral science (pp.617–623). Chichester, UK: Wiley.Google Scholar
  29. MacCallum, R. C., Browne, M. W., & Cai, L. (2006). Testing differences between nested covariance structure models: Power analysis and null hypotheses. Psychological Methods, 11, 19–35.PubMedCrossRefGoogle Scholar
  30. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224–253.CrossRefGoogle Scholar
  31. McNaught, M., Caputi, P., Oades, L. G., & Deane, F. P. (2007). Testing the validity of the recovery assessment scale using an Australian sample. Australian and New Zealand Journal of Psychiatry, 41, 450–457.PubMedCrossRefGoogle Scholar
  32. Meredith, W., & Tresi, J. A. (2006). An essay on measurement and factorial invariance. Medical Care, 44(11), 69–77.CrossRefGoogle Scholar
  33. Muramoto, Y. (2003). An indirect self-enhancement in relationship among Japanese. Journal of Cross-Cultural Psychology, 34, 552–566.CrossRefGoogle Scholar
  34. Ogawa, K., Miya, M., Watarai, A., Nakazawa, M., Yuasa, S., & Utena, H. (1987). A long-term follow-up study of schizophrenia in Japan, with special reference to the course of social adjustment. British Journal of Psychiatry, 151, 758–765.PubMedCrossRefGoogle Scholar
  35. President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final Report. Washington, DC: Department of Health and Human Services.Google Scholar
  36. Rapp, C. A., & Goscha, R. J. (2006). The strengths model: Case management with people with psychiatric disabilities (2nd ed.). New York: Oxford University Press.Google Scholar
  37. Roe, D., & Davidson, L. (2008). Recovery. In K. T. Mueser & D. V. Jeste (Eds.), Clinical handbook of schizophrenia (pp. 566–574). New York: Guilford.Google Scholar
  38. Schmitt, N., & Kuljanin, G. (2008). Measurement invariance: Review of practice and implications. Human Resource Management Review, 18, 210–222.CrossRefGoogle Scholar
  39. Slade, M., Amering, M., & Oades, L. (2008). Recovery: An international perspective. Epidemiologia e Psichiatria Sociale, 17, 128–137.PubMedGoogle Scholar
  40. Steenkamp, J., & Baumgartner, H. (1998). Assessing measurement invariance in cross-national consumer research. Journal of Consumer Research, 25, 78–90.CrossRefGoogle Scholar
  41. Tanaka, H. (2010). History of the concept of recovery. Japanese Journal of Psychiatric Clinical Services, 10, 428–433. (in Japanese).Google Scholar
  42. Tsuang, M. T., Woolson, R. F., & Fleming, J. A. (1979). Long-term outcome of major psychosis. Archives of General Psychiatry, 36, 1295–1301.PubMedCrossRefGoogle Scholar
  43. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Center for Mental Health Services. (2005). National Consensus Statement on Mental Health Recovery 2005. Profile available at:
  44. Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3(1), 4–70.CrossRefGoogle Scholar
  45. Warner, R. (1992). Commentary of Cohen, prognosis for schizophrenia in the third world. Culture, Medicine and Psychiatry, 16, 41–48.CrossRefGoogle Scholar
  46. Wicherts, J. M., & Dolan, C. V. (2010). Measurement invariance in confirmatory factor analysis: An illustration using IQ test performance of minorities. Educational Measurement: Issues and Practice, 29, 39–47.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Center for Research Methods and Data Analysis, School of Social Welfare Office of Mental Health Research and TrainingThe University of KansasLawrenceUSA
  2. 2.Osaka City UniversitySugimoto Sumiyoshi-ku OsakaJapan
  3. 3.School of Social Welfare Office of Mental Health Research and TrainingThe University of KansasLawrenceUSA

Personalised recommendations